Midway Health SystemMarion, Ohio
Sharon Brown
Revenue Cycle Management
Team Members
Chase Beekman
Sharon Brown
Brittany Edwards
Sharon Goin
Sharon Brown
Our Mission…
Midway Health System’s mission is to provide comprehensive coding quality for
productivity improvement, while providing superior patient satisfaction. Our coding
process evaluates and identifies areas where improvements are needed.
We strive to obtain timely and accurate reimbursement for our customers in lieu of
services provided. This is accomplished by practicing the highest level of integrity,
compliance and ethical standards. We use up to date resources within our facility for
ongoing staff development, the enhancement of the medical revenue cycle
management, and optimal reimbursement.
Sharon Brown
Our Vision…
The Health Information Management Department of Midway
Health System will strive to deliver correct and complete coding
for all medical records and assist in improving the outstanding
quality care to all patients.
Sharon Brown
Main Functions
• Admitting, patient access management• Case management• Charge capture• Health information management• Patient financial services, business office• Finance• Compliance• Information technology
Sharon Brown
Revenue Cycle Indicators to Analyze
• Value and volume of discharged, not final billed encounters
• Number of accounts receivable days• Number of bill-hold days• Percentage and amount of write-offs• Percentage of clean claims• Percentage of claims returned to
provider• Percentage of denials
• Percentage of accounts-missing documents
• Number of query forms• Percentage of late charges• Percentage of accurate registrations• Percentage of point-of-service
collections for elective procedures• Percentage of increased DRG
payments due to improved documentation and coding
Sharon Brown
Coding Compliance Plan
• Code of conduct• Policies and procedures• Education and training• Communication• Auditing• Corrective action• Reporting
Sharon Brown
Customers
External Customers-end users of our service that work outside of the facility. • Patients• Physicians• Third-party payers
Internal Customers-those individuals or departments within the organization to whom we provide a service• Employees• Administration• Registries
Sharon Brown
Purposes of AHIMA’s Code of Ethics
• Promotes high standards of HIM practice.• Identifies core values on which the HIM mission is based.• Summarizes broad ethical principles that reflect the profession's core values.• Establishes a set of ethical principles to be used to guide decision-making and actions.• Establishes a framework for professional behavior and responsibilities when professional
obligations conflict or ethical uncertainties arise.• Provides ethical principles by which the general public can hold the HIM professional
accountable.• Mentors practitioners new to the field to HIM's mission, values, and ethical principles.
Sharon Brown
Summary of Audit
Sharon Brown
Criteria Used for Audit
• MRN number• Date of service• Type of encounter• ICD-9 diagnoses codes• ICD-9 procedure codes• CPT-4 procedure codes
1 = correct
0 = incorrect
Sharon Brown
Sample of Audit Results
Sharon Brown
ICD-9 Diagnoses Codes (182 Codes)
79%
21%
Total Correct ICD-9 Codes (144)
Total Incorrect ICD-9 Codes (38)
Sharon Brown
ICD-9 Procedure Codes (18 Codes)
83%
17%
Total Correct Codes (15)
Total Incorrect Codes (3)
Sharon Brown
CPT-4 Codes (127 Codes)
75%
25%
Total Correct CPT-4 Codes (95)
Total Incorrect CPT-4 Codes (32)
Sharon Brown
E/M Codes (78 Codes)
69%
26%
5%
CPT-4 E/M Correct Codes 54
CPT-4 E/M Incorrect Codes 20
Missing Dates 4
Sharon Brown
Pathology Codes (44 Codes)
ICD-9 Diagnoses Codes Correct
ICD-9 Diagnoses Codes Incorrect
ICD-9 Procedure Codes Correct
ICD-9 Procedure codes Incorrect
CPT-4 Codes Correct CPT-4 Codes Incorrect0
2
4
6
8
10
12
14
16
18
2019
4
0
1
15
5
Sharon Brown
Procedure (Surgery) Codes (46 Codes)
ICD-9 Diagnoses Codes Correct
ICD-9 Diagnoses Codes Incorrect
ICD-9 Procedure Codes Correct
ICD-9 Procedure codes Incorrect
CPT-4 Codes Correct CPT-4 Codes Incorrect0
2
4
6
8
10
12
14
16
15
6
14
1
7
3
Sharon Brown
Radiology Codes (25 Codes)
ICD-9 Diagnoses Codes Correct
ICD-9 Diagnoses Codes Incorrect
ICD-9 Procedure Codes Correct
ICD-9 Procedure codes Incorrect
CPT-4 Codes Correct CPT-4 Codes Incorrect0
1
2
3
4
5
6
7
8
9
6 6
1
0
8
4
Sharon Brown
References
• Johns, Merida L., (2011), Health Information Management Technology, An Applied Approach, Chicago, IL, AHIMA
• http://www.asha.org/uploadedFiles/aud/CustSat11v6n2.pdf• http://
wiki.answers.com/Q/Who_are_the_external_and_internal_customers_in_health_care• http://
library.ahima.org/xpedio/groups/public/documents/ahima/bok1_024277.hcsp?dDocName=bok1_024277
Sharon Brown